Objective To investigate prognostic predictors of long-term survival of patients with cardiac amyloidosis (CA), and to determine predictive value of high-sensitivity cardiac troponin T (hs-cTnT) in CA patients. Me...Objective To investigate prognostic predictors of long-term survival of patients with cardiac amyloidosis (CA), and to determine predictive value of high-sensitivity cardiac troponin T (hs-cTnT) in CA patients. Methods We recruited 102 consecutive CA cases and followed these patients for 5 years. We described their clinical characteristics at presentation and used a new, high-sensitivity assay to determine the concentration of cTnT in plasma samples from these patients. Results The patients with poor prognosis showed older age (56 ±12 years vs. 50 ±15 years, P=0.022), higher incidences of heart failure (36.92%vs. 16.22%, P=0.041), pericardial effusion (60.00%vs. 35.14%, P=0.023), greater thickness of interventricular septum (IVS) (15 ±4 mm vs. 13 ±4 mm, P=0.034), higher level of hs-cTnT (0.186 ±0.249 ng/mL vs. 0.044 ±0.055 ng/mL, P=0.001) and higher NT-proBNP (N-terminal pro-B-type natriuretic pep-tide) levels (11,742 ± 10,464 pg/mL vs. 6,031 ± 7,458 pg/mL, P=0.006). At multivariate Cox regression analysis, heart failure (HR:1.78, 95%CI:1.09-2.92, P=0.021), greater wall thickness of IVS (HR:1.44, 95%CI:1.04-3.01, P=0.0375) and higher hs-cTnT level (HR:6.16, 95%CI:2.20-17.24, P=0.001) at enrollment emerged as independent predictors of all-cause mortality. Conclusions We showed that hs-cTnT is associated with a very ominous prognosis, and it is also the strongest predictor of all-cause mortality in multivariate analysis. Examination of hs-cTnT concentrations provides valuable prognostic information concerning long-term outcomes.展开更多
BACKGROUND:Early reperfusion can effectively treat acute myocardial infarction(AMI) and reduce the mortality signif icantly. This study aimed to compare the role of plasma microRNA-1(miR-1) and cardiac troponin T(cTnT...BACKGROUND:Early reperfusion can effectively treat acute myocardial infarction(AMI) and reduce the mortality signif icantly. This study aimed to compare the role of plasma microRNA-1(miR-1) and cardiac troponin T(cTnT) in early diagnosis of AMI patients.METHODS:From May 2011 to May 2012,plasma samples were collected from 56 AMI patients and 28 non-AMI controls. The expression of plasma miR-1 was measured by quantitative reverse transcription-polymerase chain reaction(qRT-PCR),and the level of plasma cTnT was measured using electrochemiluminescence-based methods on an Elecsys 2010 Immunoassay Analyzer. SPSS 16.0 was used for the statistical analysis of the results. Data were expressed as mean±standard deviation unless otherwise described. The differences about clinical characteristics between the AMI patients and controls were tested using Student's t test or Fisher's exact test. The Mann-Whitney U test was conducted to compare the expression of microRNAs between the AMI patients and controls. MicroRNAs expression between different intervals of the AMI patients was compared using Wilcoxon's signed-rank test. The receiver operating characteristic(ROC) curve was established to discriminate the AMI patients from the controls.RESULTS:In the present study,the expression of plasma miR-1 was signifi cantly increased in the AMI patients compared with the healthy controls(P<0.01). The plasma miR-1 in the AMI patients decreased to the normal level at 14 days(P>0.05). The expression of plasma miR-1 was not related to the clinical characteristics of the study population(P>0.05). ROC curve analyses demonstrated that miR-1 was specifi c and sensitive for the early diagnosis of AMI,but not superior to cTnT.CONCLUSION:Plasma miR-1 could be used in the early diagnosis of AMI,but it is similar to cTnT.展开更多
The clinical value of cardiac Troponin T (cTnT) as a marker in assessing myocardial cell damage in the patients undergoing open heart surgery was studied. Serum cTnT and CK MB levels were measured in serial blood sam...The clinical value of cardiac Troponin T (cTnT) as a marker in assessing myocardial cell damage in the patients undergoing open heart surgery was studied. Serum cTnT and CK MB levels were measured in serial blood samples from 20 patients undergoing open heart surgery before operation, at aorta clamping, aorta opening, the end of CPB and the operation, and subsequently one h, one day, 3 days and one week after operation respectively. Ten patients receiving thoracic surgery were also subjected to the measurement of cTnT and CK MB before and 24 h after operation. The results showed that peak concentrations were reached earlier in cTnT than in CK MB, and the circulation cTnT remained high when CK MB had already decreased to normal. In 10 patients receiving thoracic surgery, cTnT level was normal and CK MB was increased in 4 patients after surgery. It was concluded that the sensitivity and specificity of cTnT was more than those of CK MB and cTnT could be used as a routine indicator for myocardiac protection.展开更多
AIM: To assess residual diuresis and diverse variables according to body mass index (BMI).METHODS: Cross-sectional study (n = 57), with 3 groups. Group A: BMI 〈 25, n = 22; Group B: BMI 25-30, n = 15; Grou...AIM: To assess residual diuresis and diverse variables according to body mass index (BMI).METHODS: Cross-sectional study (n = 57), with 3 groups. Group A: BMI 〈 25, n = 22; Group B: BMI 25-30, n = 15; Group C: BMI 〉 30, n = 20. Diuresis, hematocrit, albumin, C-reactive protein, Malnutrition infammatory score, Pro-BNP, Troponin T, leptin and in-sulin levels are expressed as median and ranges (r). RESULTS: Albumin (g/dL): GA vs GC, 3.70 (r2.20-4.90) vs 3.85 (r3.40-4.90), P = 0.02. Diuresis (mL/d): GA 690 (r0-1780); GB 660 (r60-1800); GC 840 (r40-2840). Diuresis GA vs GC, P = 0.01. Leptin (ng/mL): GA vs GC, 3.81 (r0.78-69.60) vs GC, 32.80 (r0.78-124.50), P 〈 0.001. Insulin (μU/mL): GA vs GB, 7 (r2-44) vs 11.50 (r4-38), P = 0.02; GA vs GC, 7 (r2-44) vs 19.5 (r5-155), P = 0.0001. Troponin T and Pro-BNP levels were not different. Significant correlations: GC, Insulin-UF: ρ= 0.53; P = 0.03; TroponinT-diuresis: ρ = -0.48, P 〈 0.05; Pro-BNP-diuresis: ρ = -0.39, P 〈 0.01; Troponin T-ProBNP: ρ = 0.77, P 〈 0.0001; albumin-Troponin T: ρ = -0.66, P 〈 0.0001; albumin-ProBNP: ρ = -0.44, P 〈 0.05.CONCLUSION: High BMI associated positively with higher diuresis and albuminemia, and negatively with TropT and Pro-BNP. High BMI-associated better survival may be explained by better urinary output, lowering cardiovascular stress.展开更多
Our first intention to treat infants’ heart failure with beta blockers was to improve the clinical condition as shown in our prospective randomized trial. We only use non-selective beta blockers in these infants, car...Our first intention to treat infants’ heart failure with beta blockers was to improve the clinical condition as shown in our prospective randomized trial. We only use non-selective beta blockers in these infants, carvedilol in those with left ventricular dysfunction and propranolol in those with congenital heart disease without ventricular dysfunction. Despite a significant improvement of Ross’s heart failure score, we could not convince most colleagues within the last 25 years if the concept of neurohumoral activation in heart failure is not well-established pediatric cardiology. Recently, Honghai Liu et al. published that cardiomyocyte cytokinesis failure was increased in congenital heart disease. Inactivation of the beta adreno receptors genes and administration of the beta-blocker propranolol increased cardiomyocyte division in neonatal mice, which increased the number of cardiomyocytes (endowment) and conferred benefit after myocardial infarction in adults. We currently realize that propranolol in infants with congenital heart disease not only decrease highly elevated NT-Pro-BNP values but also decrease cardiac troponin T values that may indicate myocardial injury due to neurohumoral activation. We reproduce this observation, primarily seen in infants with congenital heart disease, in an infant with Duchenne muscular dystrophy. These observations were in good accordance with current data from H. Liu et al., who showed that treatment with non-selective beta blockers early after birth might rescue cytokinesis defects and prevent heart dysfunction in adulthood in a mouse model.展开更多
Background:To finish an endurance race,athletes perform a vigorous effort that induces the release of cardiac damage markers.There are several factors that can affect the total number of these markers,so the aim of th...Background:To finish an endurance race,athletes perform a vigorous effort that induces the release of cardiac damage markers.There are several factors that can affect the total number of these markers,so the aim of this review was to analyze the effect of endurance running races on cardiac damage markers and to identify the factors that modify the levels of segregation of these cardiac damage markers.Methods:A systematic search of PubMed,Web of Science,and the Cochrane Library databases was performed.This analysis included studies where the acute effects of running races on cardiac damage markers(troponin I and troponin T)were analyzed,assessing the levels of these markers before and after the races.Results:The effects of running races on troponin I(mean difference=0.0381 ng/mL)and troponin T(mean difference=0.0256 ng/mL)levels were significant.The ages(R^(2)=14.4%,p=0.033)and body mass indexes(R^(2)=14.5%,p=0.045)of the athletes had a significant interaction with troponin I.In addition,gender,mean speed,time to finish the race,and type of race can affect the level of cardiac damage markers.Conclusion:Endurance running races induce the release of cardiac-damage markers that remain elevated for at least 24 h after the races.In addition,young male athletes with high body mass indexes who perform races combining long duration and moderate intensity(i.e.,marathons)release the highest levels of cardiac damage markers.Physicians should take into consideration these results in the diagnosis and treatment of patients admitted to the hospital days after finishing endurance running races.展开更多
BACKGROUND Cardiac involvement in neonates with perinatal asphyxia not only complicates perinatal management but also contributes to increased mortality.AIM To assess cardiac troponin T(cTnT)levels in asphyxiated neon...BACKGROUND Cardiac involvement in neonates with perinatal asphyxia not only complicates perinatal management but also contributes to increased mortality.AIM To assess cardiac troponin T(cTnT)levels in asphyxiated neonates and their correlation with echocardiography findings,inotrope requirement,hypoxicischemic encephalopathy(HIE)stages,and mortality.METHODS cTnT levels,echocardiographic findings,the requirement of inotropes,HIE stages,and outcome were studied in neonates of gestational age≥34 wk with perinatal asphyxia.RESULTS Among 57 neonates with perinatal asphyxia,male gender,cesarean section,forceps/vacuum-assisted vaginal delivery and late preterm included 33(57.9%),23(40.4%),3(5.3%),and 12(21.1%)respectively.The mean gestational age was 38.4 wk(1.6 wk).HIE stages I,II,and III were observed in 7(12.3%),37(64.9%),and 9(15.8%)neonates respectively.26(45.6%)neonates had echocardiographic changes and 19(33.3%)required inotropes.cTnT levels were elevated in 41(71.9%)neonates[median(IQR);0.285(0.211-0.422)ng/mL].The Median cTnT level showed an increasing trend with increasing changes in echocardiography(P=0.002).Two neonates with mitral regurgitation and global hypokinesia had the highest cTnT levels(1.99 and 0.651 ng/mL).Of 31 neonates with normal echocardiography,18(58.06%)showed elevated cTnT.cTnT levels were significantly higher in those who required inotropic support than those who did not(P=0.007).Neonates with HIE stage III had significantly higher cTnT levels compared to those with HIE stage I/II(P=0.013).Survivors had lower median cTnT levels[0.210(0.122-0.316)ng/mL]than who succumbed[0.597(0.356-1.146)ng/mL].CONCLUSION cTnT levels suggestive of cardiac involvement were observed in 71.9%of asphyxiated neonates.cTnT levels correlated with echocardiography findings,inotrope requirement,HIE stages,and mortality.展开更多
Objectives Evaluation of patients with acute chest pain when they admitted is time-consuming. We prospectively investigated the role of bedside troponin T test for predicting the risk of death and acute heart failure ...Objectives Evaluation of patients with acute chest pain when they admitted is time-consuming. We prospectively investigated the role of bedside troponin T test for predicting the risk of death and acute heart failure of patients with acute chest pain.Methods and Results 502 consecutive patients with chest pain for less than 24 hours were determined by troponin T test at bedside and quantitative troponin I test in lab. For bedside troponin T tests, there were 160 patients in positive and 323 in negative. During 30 days of followed-up. Myocardial infarction evolved in 139 patients among 160 patients in positive troponin T test, only 7 patients in negative one. Acute heart failure occurred in 51 patients among the positive group, but 37 occurred it at negative group. The odds ratio of acute heart failure of positive group vs. negative group was 3.6. Patients died 39 in positive group, 15 in negative group, the all-cause death odds ratio of positive group vs. negative group was 6.7; 31 patients died with cardiac event in positive group, 5 in negative group only. Conclusions Bedside Troponin T test is a powerful and independent predictor of death and acute heart failure for patients with acute chest pain.展开更多
Background N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are excellent biomarkers for detecting heart failure and subclinical myocardial injury.However,it ...Background N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are excellent biomarkers for detecting heart failure and subclinical myocardial injury.However,it remains unclear whether subclinical myocardial injury is associated with NT-proBNP elevation in a community based population.Methods In a community based study,levels of hs-cTnT and of NT-proBNP were determined in 1 497 participants older than 45 years.The lower detection limit of the hs-cTnT assay used in the present study was 0.003 ng/ml.The association of hs-cTnT levels and NT-proBNP levels was analyzed.Results When the subjects with undetectable (〈0.003 ng/ml),intermediate (0.003-0.014 ng/ml),and elevated (≥0.014 ng/ml) levels of hs-cTnT were compared (r=0.175,P 〈0.001),a strong association between the hs-cTnT levels and NT-proBNP levels was observed (β=-0.206,P 〈0.001; β=-0.118,P 〈0.001,respectively).In multivariable analyses,older age and hs-cTnT were positively and independently associated with NT-proBNP levels (β=0.341,P 〈0.001; β=0.143,P 〈0.001,respectively),and male gender and the levels of eGFR were inversely and independently associated with NT-proBNP levels.When the subjects with normal or elevated NT-proBNP were analyzed separately,the hs-cTnT level was not an independent predictor for the NT-proBNP level in the normal NT-proBNP group,whereas the hs-cTnT level was the only independent predictor for NT-proBNP level in the elevated NT-proBNP group (β=0.399,P 〈0.01).Conclusions In this community based population,NT-proBNP elevation was common.In addition to female gender and older age,subclinical myocardial injury indicated by the hs-cTnT level was another important factor in NT-proBNP elevation.展开更多
Objective To determine whether the level of serum cardiac troponin T (cTnT) was increased in patients with congestive heart failure (CHF). Methods This study consisted of 265 patients with CHF and 75 healthy people. S...Objective To determine whether the level of serum cardiac troponin T (cTnT) was increased in patients with congestive heart failure (CHF). Methods This study consisted of 265 patients with CHF and 75 healthy people. Serum cTnT was measured by electrochemiluminescence immunoassay using an Elecsys 1010 automatic analyzer. Results cTnT concentration was 0.181±0.536 ng/mL in CHF patients and 0.003±0.001 ng/mL in controls (P<0.001). Patients were categorized according to the levels of heart function and left ventricular ejection fraction (LVEF). In the first group consisting of 105 patients with LVEF≤35%, cTnT was 0.311±0.221 ng/mL. In the second group of 106 patients with LVEF>35%, cTnT was 0.07±0.0 5ng/mL (P<0.01). In patients with NYHA class Ⅰ, Ⅱ, Ⅲ and Ⅳ, cTnT values were 0.062±0.022 ng/mL, 0.113±0.121 mg/mL, 0.191±0.231 mg/ml and 0.384±0.211 mg/mL, respectively (class Ⅰ vs class Ⅱ P>0.05, class Ⅱ vs class Ⅲ P<0.01, class Ⅲ vs class Ⅳ P<0.01). A negative correlation was observed between serum cTnT concentration and LVEF in 265 patients with CHF (r=-0.493, P<0.001).Conclusions This study shows that the level of serum cTnT is increased in patients with CHF and that the increased level indicates the severity of CHF.展开更多
The release kinetics of the cardiac specific troponin T (cTnT), measured by an immunosorbent assay, in 32 patients with acute myocardial infarction (AMI) was evaluated. In 8 AMI patients (25%), the release kinetics of...The release kinetics of the cardiac specific troponin T (cTnT), measured by an immunosorbent assay, in 32 patients with acute myocardial infarction (AMI) was evaluated. In 8 AMI patients (25%), the release kinetics of serum cTnT showed biphasic serum concentration curves with a large peak at 10 to 18 hours after onset and the serum cTnT concentrations were up to 30 to 120 times of the normal upper limit-detected (0.2 μg / ml), and another samll cTnT peak at 70 to 100 hours after onset of pain. The serum cTnT measurements in the remaining 24 AMI patients (75%) gave only one large peak which was around 32 to 108 hours after onset of pain. cTnT appeared in serum as early as 3 to 4 hours and remained elevated until 240 hours after the infarctions. The results indicated that (1) cTnT was a sensitive and specific marker of AMI; (2) the biphasic curve of cTnT releae in general, the ratio of cTnT at around 14 to 32 (14/32)>1 in particular, may be a useful marker suggesting early reperfusion; (3) the continuous elevation of serum cTnT in AMI course might be a prognostic indicator for unfavorable outcomes.展开更多
Background Paucity of data is available on the in-hospital and 28-day prognostic value of at-admission highsensitivity troponin T(hs-TnT)level in elderly patients with sepsis admitted to intensive care units.Methods P...Background Paucity of data is available on the in-hospital and 28-day prognostic value of at-admission highsensitivity troponin T(hs-TnT)level in elderly patients with sepsis admitted to intensive care units.Methods Patients aged 65 or older with sepsis or septic shock admitted to geriatric ICU in Guangdong Provincial People’s Hospital between January 2010 and December 2017 were enrolled in the study.Receiver operator characteristic(ROC)curve analysis was performed to evaluate the predictive value of hs-TnT for in-hospital mortality.Multivariate Cox survival regression was used to determine independent risk factor of hs-TnT for 28-day death.Results The in-hospital mortality was 64.4%.According to the receiver operator characteristic(ROC)curve analysis,the cut-off for predicting in-hospital death was 65.2 pg/mL.Patients with elevated hs-TnT had a higher rate of in-hospital mortality(75%vs.53.4%,P<0.001)and 28-day mortality(47.7%vs.27.6%,P<0.001).Multivariate regression showed that lg(hs-TnT)was an independent risk factor for in-hospital death(adjusted HR:1.53,95%CI:1.16-2.01,P=0.03).Kaplan-Meier survival curves showed that elderly patients with at-admission hs-TnT>65.2 pg/mL had a worse outcome than those with hs-TnT<65.2 pg/mL(Log-rank test:17.46,P=0.000).Conclusions In elderly patients with sepsis admitted to intensive care units,elevated hs-TnT level measured upon admission was associated with increased mortality rate.hs-TnT independently contributed to the prediction of 28-day mortality.展开更多
Background:Biochemical analyses of N‑terminal pro‑brain natriuretic peptide(NT‑proBNP),cardiac troponin T(cTnT),and creatine kinase MB(CK‑MB)have been reported to be valuable for the auxiliary diagnosis of sudden card...Background:Biochemical analyses of N‑terminal pro‑brain natriuretic peptide(NT‑proBNP),cardiac troponin T(cTnT),and creatine kinase MB(CK‑MB)have been reported to be valuable for the auxiliary diagnosis of sudden cardiac death(SCD)in previous forensic studies.Aims and Objectives:The present study aimed to evaluate the diagnostic efficiency of combined analyses of NT‑proBNP,cTnT and CK‑MB in the pericardial fluid for forensic diagnosis of SCD caused by ischemic heart disease.Materials and Methods:Levels of NT‑proBNP,cTnT,and CK‑MB in the pericardial fluid of 132 medicolegal autopsy cases were obtained through electrochemiluminescence method.Results:NT‑proBNP,cTnT,and CK‑MB levels were significantly elevated in SCD cases(P<0.05).Receiver‑operating characteristics(ROC)analysis showed that NT‑proBNP,cTnT,and CK‑MB have diagnostic value for the diagnosis of SCD:NT‑proBNP,cutoff value of 2236 pg/ml;cTnT,cutoff value of 199.51 ng/ml;CK‑MB:cutoff value of 2742.5 ng/ml,and the combined analyses of these three biomarkers have better diagnostic efficiency than each single biomarker alone.Moreover,the causes of SCD were sub‑divided into acute ischemic heart disease,acute myocardial infarction(AMI),and recurrent myocardial infarction subgroups for further analysis,which revealed that the ratio of cTnT/CK‑MB could be used to distinguish AMI with the cutoff value of 0.1085 estimated by ROC analysis.Conclusion:These observations suggested that the postmortem biochemical analyses of NT‑proBNP,cTnT,and CK‑MB in the pericardial fluid may assist to diagnose SCD in forensic practice,and the combined analyses of multiple biomarkers have better diagnostic efficiency than each single biomarker alone.On the basis of the postmortem biochemical analyses of NT‑proBNP,cTnT and CK‑MB,combining the ratio of cTnT/CK‑MB could be used to distinguish AMI.展开更多
文摘Objective To investigate prognostic predictors of long-term survival of patients with cardiac amyloidosis (CA), and to determine predictive value of high-sensitivity cardiac troponin T (hs-cTnT) in CA patients. Methods We recruited 102 consecutive CA cases and followed these patients for 5 years. We described their clinical characteristics at presentation and used a new, high-sensitivity assay to determine the concentration of cTnT in plasma samples from these patients. Results The patients with poor prognosis showed older age (56 ±12 years vs. 50 ±15 years, P=0.022), higher incidences of heart failure (36.92%vs. 16.22%, P=0.041), pericardial effusion (60.00%vs. 35.14%, P=0.023), greater thickness of interventricular septum (IVS) (15 ±4 mm vs. 13 ±4 mm, P=0.034), higher level of hs-cTnT (0.186 ±0.249 ng/mL vs. 0.044 ±0.055 ng/mL, P=0.001) and higher NT-proBNP (N-terminal pro-B-type natriuretic pep-tide) levels (11,742 ± 10,464 pg/mL vs. 6,031 ± 7,458 pg/mL, P=0.006). At multivariate Cox regression analysis, heart failure (HR:1.78, 95%CI:1.09-2.92, P=0.021), greater wall thickness of IVS (HR:1.44, 95%CI:1.04-3.01, P=0.0375) and higher hs-cTnT level (HR:6.16, 95%CI:2.20-17.24, P=0.001) at enrollment emerged as independent predictors of all-cause mortality. Conclusions We showed that hs-cTnT is associated with a very ominous prognosis, and it is also the strongest predictor of all-cause mortality in multivariate analysis. Examination of hs-cTnT concentrations provides valuable prognostic information concerning long-term outcomes.
基金supported by grants from the National Natural Science Foundation of China(81071030)the Science and Technology Foundation of Guangdong Province(2011B080701006)
文摘BACKGROUND:Early reperfusion can effectively treat acute myocardial infarction(AMI) and reduce the mortality signif icantly. This study aimed to compare the role of plasma microRNA-1(miR-1) and cardiac troponin T(cTnT) in early diagnosis of AMI patients.METHODS:From May 2011 to May 2012,plasma samples were collected from 56 AMI patients and 28 non-AMI controls. The expression of plasma miR-1 was measured by quantitative reverse transcription-polymerase chain reaction(qRT-PCR),and the level of plasma cTnT was measured using electrochemiluminescence-based methods on an Elecsys 2010 Immunoassay Analyzer. SPSS 16.0 was used for the statistical analysis of the results. Data were expressed as mean±standard deviation unless otherwise described. The differences about clinical characteristics between the AMI patients and controls were tested using Student's t test or Fisher's exact test. The Mann-Whitney U test was conducted to compare the expression of microRNAs between the AMI patients and controls. MicroRNAs expression between different intervals of the AMI patients was compared using Wilcoxon's signed-rank test. The receiver operating characteristic(ROC) curve was established to discriminate the AMI patients from the controls.RESULTS:In the present study,the expression of plasma miR-1 was signifi cantly increased in the AMI patients compared with the healthy controls(P<0.01). The plasma miR-1 in the AMI patients decreased to the normal level at 14 days(P>0.05). The expression of plasma miR-1 was not related to the clinical characteristics of the study population(P>0.05). ROC curve analyses demonstrated that miR-1 was specifi c and sensitive for the early diagnosis of AMI,but not superior to cTnT.CONCLUSION:Plasma miR-1 could be used in the early diagnosis of AMI,but it is similar to cTnT.
文摘The clinical value of cardiac Troponin T (cTnT) as a marker in assessing myocardial cell damage in the patients undergoing open heart surgery was studied. Serum cTnT and CK MB levels were measured in serial blood samples from 20 patients undergoing open heart surgery before operation, at aorta clamping, aorta opening, the end of CPB and the operation, and subsequently one h, one day, 3 days and one week after operation respectively. Ten patients receiving thoracic surgery were also subjected to the measurement of cTnT and CK MB before and 24 h after operation. The results showed that peak concentrations were reached earlier in cTnT than in CK MB, and the circulation cTnT remained high when CK MB had already decreased to normal. In 10 patients receiving thoracic surgery, cTnT level was normal and CK MB was increased in 4 patients after surgery. It was concluded that the sensitivity and specificity of cTnT was more than those of CK MB and cTnT could be used as a routine indicator for myocardiac protection.
文摘AIM: To assess residual diuresis and diverse variables according to body mass index (BMI).METHODS: Cross-sectional study (n = 57), with 3 groups. Group A: BMI 〈 25, n = 22; Group B: BMI 25-30, n = 15; Group C: BMI 〉 30, n = 20. Diuresis, hematocrit, albumin, C-reactive protein, Malnutrition infammatory score, Pro-BNP, Troponin T, leptin and in-sulin levels are expressed as median and ranges (r). RESULTS: Albumin (g/dL): GA vs GC, 3.70 (r2.20-4.90) vs 3.85 (r3.40-4.90), P = 0.02. Diuresis (mL/d): GA 690 (r0-1780); GB 660 (r60-1800); GC 840 (r40-2840). Diuresis GA vs GC, P = 0.01. Leptin (ng/mL): GA vs GC, 3.81 (r0.78-69.60) vs GC, 32.80 (r0.78-124.50), P 〈 0.001. Insulin (μU/mL): GA vs GB, 7 (r2-44) vs 11.50 (r4-38), P = 0.02; GA vs GC, 7 (r2-44) vs 19.5 (r5-155), P = 0.0001. Troponin T and Pro-BNP levels were not different. Significant correlations: GC, Insulin-UF: ρ= 0.53; P = 0.03; TroponinT-diuresis: ρ = -0.48, P 〈 0.05; Pro-BNP-diuresis: ρ = -0.39, P 〈 0.01; Troponin T-ProBNP: ρ = 0.77, P 〈 0.0001; albumin-Troponin T: ρ = -0.66, P 〈 0.0001; albumin-ProBNP: ρ = -0.44, P 〈 0.05.CONCLUSION: High BMI associated positively with higher diuresis and albuminemia, and negatively with TropT and Pro-BNP. High BMI-associated better survival may be explained by better urinary output, lowering cardiovascular stress.
文摘Our first intention to treat infants’ heart failure with beta blockers was to improve the clinical condition as shown in our prospective randomized trial. We only use non-selective beta blockers in these infants, carvedilol in those with left ventricular dysfunction and propranolol in those with congenital heart disease without ventricular dysfunction. Despite a significant improvement of Ross’s heart failure score, we could not convince most colleagues within the last 25 years if the concept of neurohumoral activation in heart failure is not well-established pediatric cardiology. Recently, Honghai Liu et al. published that cardiomyocyte cytokinesis failure was increased in congenital heart disease. Inactivation of the beta adreno receptors genes and administration of the beta-blocker propranolol increased cardiomyocyte division in neonatal mice, which increased the number of cardiomyocytes (endowment) and conferred benefit after myocardial infarction in adults. We currently realize that propranolol in infants with congenital heart disease not only decrease highly elevated NT-Pro-BNP values but also decrease cardiac troponin T values that may indicate myocardial injury due to neurohumoral activation. We reproduce this observation, primarily seen in infants with congenital heart disease, in an infant with Duchenne muscular dystrophy. These observations were in good accordance with current data from H. Liu et al., who showed that treatment with non-selective beta blockers early after birth might rescue cytokinesis defects and prevent heart dysfunction in adulthood in a mouse model.
文摘Background:To finish an endurance race,athletes perform a vigorous effort that induces the release of cardiac damage markers.There are several factors that can affect the total number of these markers,so the aim of this review was to analyze the effect of endurance running races on cardiac damage markers and to identify the factors that modify the levels of segregation of these cardiac damage markers.Methods:A systematic search of PubMed,Web of Science,and the Cochrane Library databases was performed.This analysis included studies where the acute effects of running races on cardiac damage markers(troponin I and troponin T)were analyzed,assessing the levels of these markers before and after the races.Results:The effects of running races on troponin I(mean difference=0.0381 ng/mL)and troponin T(mean difference=0.0256 ng/mL)levels were significant.The ages(R^(2)=14.4%,p=0.033)and body mass indexes(R^(2)=14.5%,p=0.045)of the athletes had a significant interaction with troponin I.In addition,gender,mean speed,time to finish the race,and type of race can affect the level of cardiac damage markers.Conclusion:Endurance running races induce the release of cardiac-damage markers that remain elevated for at least 24 h after the races.In addition,young male athletes with high body mass indexes who perform races combining long duration and moderate intensity(i.e.,marathons)release the highest levels of cardiac damage markers.Physicians should take into consideration these results in the diagnosis and treatment of patients admitted to the hospital days after finishing endurance running races.
文摘BACKGROUND Cardiac involvement in neonates with perinatal asphyxia not only complicates perinatal management but also contributes to increased mortality.AIM To assess cardiac troponin T(cTnT)levels in asphyxiated neonates and their correlation with echocardiography findings,inotrope requirement,hypoxicischemic encephalopathy(HIE)stages,and mortality.METHODS cTnT levels,echocardiographic findings,the requirement of inotropes,HIE stages,and outcome were studied in neonates of gestational age≥34 wk with perinatal asphyxia.RESULTS Among 57 neonates with perinatal asphyxia,male gender,cesarean section,forceps/vacuum-assisted vaginal delivery and late preterm included 33(57.9%),23(40.4%),3(5.3%),and 12(21.1%)respectively.The mean gestational age was 38.4 wk(1.6 wk).HIE stages I,II,and III were observed in 7(12.3%),37(64.9%),and 9(15.8%)neonates respectively.26(45.6%)neonates had echocardiographic changes and 19(33.3%)required inotropes.cTnT levels were elevated in 41(71.9%)neonates[median(IQR);0.285(0.211-0.422)ng/mL].The Median cTnT level showed an increasing trend with increasing changes in echocardiography(P=0.002).Two neonates with mitral regurgitation and global hypokinesia had the highest cTnT levels(1.99 and 0.651 ng/mL).Of 31 neonates with normal echocardiography,18(58.06%)showed elevated cTnT.cTnT levels were significantly higher in those who required inotropic support than those who did not(P=0.007).Neonates with HIE stage III had significantly higher cTnT levels compared to those with HIE stage I/II(P=0.013).Survivors had lower median cTnT levels[0.210(0.122-0.316)ng/mL]than who succumbed[0.597(0.356-1.146)ng/mL].CONCLUSION cTnT levels suggestive of cardiac involvement were observed in 71.9%of asphyxiated neonates.cTnT levels correlated with echocardiography findings,inotrope requirement,HIE stages,and mortality.
文摘Objectives Evaluation of patients with acute chest pain when they admitted is time-consuming. We prospectively investigated the role of bedside troponin T test for predicting the risk of death and acute heart failure of patients with acute chest pain.Methods and Results 502 consecutive patients with chest pain for less than 24 hours were determined by troponin T test at bedside and quantitative troponin I test in lab. For bedside troponin T tests, there were 160 patients in positive and 323 in negative. During 30 days of followed-up. Myocardial infarction evolved in 139 patients among 160 patients in positive troponin T test, only 7 patients in negative one. Acute heart failure occurred in 51 patients among the positive group, but 37 occurred it at negative group. The odds ratio of acute heart failure of positive group vs. negative group was 3.6. Patients died 39 in positive group, 15 in negative group, the all-cause death odds ratio of positive group vs. negative group was 6.7; 31 patients died with cardiac event in positive group, 5 in negative group only. Conclusions Bedside Troponin T test is a powerful and independent predictor of death and acute heart failure for patients with acute chest pain.
基金This study was supported by grants from the National Basic Research Program of China,Nature Science Foundation of China
文摘Background N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are excellent biomarkers for detecting heart failure and subclinical myocardial injury.However,it remains unclear whether subclinical myocardial injury is associated with NT-proBNP elevation in a community based population.Methods In a community based study,levels of hs-cTnT and of NT-proBNP were determined in 1 497 participants older than 45 years.The lower detection limit of the hs-cTnT assay used in the present study was 0.003 ng/ml.The association of hs-cTnT levels and NT-proBNP levels was analyzed.Results When the subjects with undetectable (〈0.003 ng/ml),intermediate (0.003-0.014 ng/ml),and elevated (≥0.014 ng/ml) levels of hs-cTnT were compared (r=0.175,P 〈0.001),a strong association between the hs-cTnT levels and NT-proBNP levels was observed (β=-0.206,P 〈0.001; β=-0.118,P 〈0.001,respectively).In multivariable analyses,older age and hs-cTnT were positively and independently associated with NT-proBNP levels (β=0.341,P 〈0.001; β=0.143,P 〈0.001,respectively),and male gender and the levels of eGFR were inversely and independently associated with NT-proBNP levels.When the subjects with normal or elevated NT-proBNP were analyzed separately,the hs-cTnT level was not an independent predictor for the NT-proBNP level in the normal NT-proBNP group,whereas the hs-cTnT level was the only independent predictor for NT-proBNP level in the elevated NT-proBNP group (β=0.399,P 〈0.01).Conclusions In this community based population,NT-proBNP elevation was common.In addition to female gender and older age,subclinical myocardial injury indicated by the hs-cTnT level was another important factor in NT-proBNP elevation.
文摘Objective To determine whether the level of serum cardiac troponin T (cTnT) was increased in patients with congestive heart failure (CHF). Methods This study consisted of 265 patients with CHF and 75 healthy people. Serum cTnT was measured by electrochemiluminescence immunoassay using an Elecsys 1010 automatic analyzer. Results cTnT concentration was 0.181±0.536 ng/mL in CHF patients and 0.003±0.001 ng/mL in controls (P<0.001). Patients were categorized according to the levels of heart function and left ventricular ejection fraction (LVEF). In the first group consisting of 105 patients with LVEF≤35%, cTnT was 0.311±0.221 ng/mL. In the second group of 106 patients with LVEF>35%, cTnT was 0.07±0.0 5ng/mL (P<0.01). In patients with NYHA class Ⅰ, Ⅱ, Ⅲ and Ⅳ, cTnT values were 0.062±0.022 ng/mL, 0.113±0.121 mg/mL, 0.191±0.231 mg/ml and 0.384±0.211 mg/mL, respectively (class Ⅰ vs class Ⅱ P>0.05, class Ⅱ vs class Ⅲ P<0.01, class Ⅲ vs class Ⅳ P<0.01). A negative correlation was observed between serum cTnT concentration and LVEF in 265 patients with CHF (r=-0.493, P<0.001).Conclusions This study shows that the level of serum cTnT is increased in patients with CHF and that the increased level indicates the severity of CHF.
文摘The release kinetics of the cardiac specific troponin T (cTnT), measured by an immunosorbent assay, in 32 patients with acute myocardial infarction (AMI) was evaluated. In 8 AMI patients (25%), the release kinetics of serum cTnT showed biphasic serum concentration curves with a large peak at 10 to 18 hours after onset and the serum cTnT concentrations were up to 30 to 120 times of the normal upper limit-detected (0.2 μg / ml), and another samll cTnT peak at 70 to 100 hours after onset of pain. The serum cTnT measurements in the remaining 24 AMI patients (75%) gave only one large peak which was around 32 to 108 hours after onset of pain. cTnT appeared in serum as early as 3 to 4 hours and remained elevated until 240 hours after the infarctions. The results indicated that (1) cTnT was a sensitive and specific marker of AMI; (2) the biphasic curve of cTnT releae in general, the ratio of cTnT at around 14 to 32 (14/32)>1 in particular, may be a useful marker suggesting early reperfusion; (3) the continuous elevation of serum cTnT in AMI course might be a prognostic indicator for unfavorable outcomes.
基金the Project of Administration of Traditional Chinese Medicine of Guangdong Province of China(No.20191050)the Medical Scientific Research Foudation of Guangdong Province of China(No.A2020620)。
文摘Background Paucity of data is available on the in-hospital and 28-day prognostic value of at-admission highsensitivity troponin T(hs-TnT)level in elderly patients with sepsis admitted to intensive care units.Methods Patients aged 65 or older with sepsis or septic shock admitted to geriatric ICU in Guangdong Provincial People’s Hospital between January 2010 and December 2017 were enrolled in the study.Receiver operator characteristic(ROC)curve analysis was performed to evaluate the predictive value of hs-TnT for in-hospital mortality.Multivariate Cox survival regression was used to determine independent risk factor of hs-TnT for 28-day death.Results The in-hospital mortality was 64.4%.According to the receiver operator characteristic(ROC)curve analysis,the cut-off for predicting in-hospital death was 65.2 pg/mL.Patients with elevated hs-TnT had a higher rate of in-hospital mortality(75%vs.53.4%,P<0.001)and 28-day mortality(47.7%vs.27.6%,P<0.001).Multivariate regression showed that lg(hs-TnT)was an independent risk factor for in-hospital death(adjusted HR:1.53,95%CI:1.16-2.01,P=0.03).Kaplan-Meier survival curves showed that elderly patients with at-admission hs-TnT>65.2 pg/mL had a worse outcome than those with hs-TnT<65.2 pg/mL(Log-rank test:17.46,P=0.000).Conclusions In elderly patients with sepsis admitted to intensive care units,elevated hs-TnT level measured upon admission was associated with increased mortality rate.hs-TnT independently contributed to the prediction of 28-day mortality.
基金funded by the National Natural Science Foundation of China(Grant No.82002001).
文摘Background:Biochemical analyses of N‑terminal pro‑brain natriuretic peptide(NT‑proBNP),cardiac troponin T(cTnT),and creatine kinase MB(CK‑MB)have been reported to be valuable for the auxiliary diagnosis of sudden cardiac death(SCD)in previous forensic studies.Aims and Objectives:The present study aimed to evaluate the diagnostic efficiency of combined analyses of NT‑proBNP,cTnT and CK‑MB in the pericardial fluid for forensic diagnosis of SCD caused by ischemic heart disease.Materials and Methods:Levels of NT‑proBNP,cTnT,and CK‑MB in the pericardial fluid of 132 medicolegal autopsy cases were obtained through electrochemiluminescence method.Results:NT‑proBNP,cTnT,and CK‑MB levels were significantly elevated in SCD cases(P<0.05).Receiver‑operating characteristics(ROC)analysis showed that NT‑proBNP,cTnT,and CK‑MB have diagnostic value for the diagnosis of SCD:NT‑proBNP,cutoff value of 2236 pg/ml;cTnT,cutoff value of 199.51 ng/ml;CK‑MB:cutoff value of 2742.5 ng/ml,and the combined analyses of these three biomarkers have better diagnostic efficiency than each single biomarker alone.Moreover,the causes of SCD were sub‑divided into acute ischemic heart disease,acute myocardial infarction(AMI),and recurrent myocardial infarction subgroups for further analysis,which revealed that the ratio of cTnT/CK‑MB could be used to distinguish AMI with the cutoff value of 0.1085 estimated by ROC analysis.Conclusion:These observations suggested that the postmortem biochemical analyses of NT‑proBNP,cTnT,and CK‑MB in the pericardial fluid may assist to diagnose SCD in forensic practice,and the combined analyses of multiple biomarkers have better diagnostic efficiency than each single biomarker alone.On the basis of the postmortem biochemical analyses of NT‑proBNP,cTnT and CK‑MB,combining the ratio of cTnT/CK‑MB could be used to distinguish AMI.